Lowering Cholesterol with Some TLC: Therapeutic Lifestyle Changes

Most people think that if they are diagnosed with high cholesterol that a prescription medication is in their immediate future. This is not necessarily the case given that there are several non-pharmaceutical ways in which you can lower your cholesterol. Unfortunately, most people eventually end up on some type of drug therapy to achieve their target goals. Any treatment of high cholesterol first begins with some TLC: therapeutic lifestyle changes. This involves three simple, yet often difficult to execute, steps: improved diet, increased physical activity, and weight management.

I’ve written quite a bit in my past articles about how a heart healthy diet can improve your cholesterol. Simple rules include eating unsaturated fats instead of saturated and trans fats, avoiding cholesterol, increasing dietary fiber, and consuming more plant sterols/stanols. Each simple change can have a significant impact on LDL reduction. If you can limit your daily saturated fat intake to less than 7% of your total calories, then LDL may fall by 8-10%. (1 gram of fat provides 9 calories, so assuming you need 2000cal/day, then your total saturated fat intake should be no more than 15 grams - that’s a quarter pounder with cheese and large fries at McDs.) If you limit your total daily cholesterol intake to less than 200mg/dl (the equivalent of one egg), then LDL can be reduced by 3-5%. Increasing soluble fiber in your diet (ie. psyllium) by 5-10grams/day can also reduce your LDL by 3-5%. By eating an additional 2 grams/day of plant sterols/stanols (a chemical similar to cholesterol that can make a margarine such as Benecol or Take control), LDL can be reduced by up to 15%. Although each dietary intervention sounds as if it only minimally contributes to LDL reduction, if you do all of these dietary changes together, then LDL may be lowered ~20%.

Exercise is good for us for so many reasons both physically and mentally. With regards to cholesterol, exercise can provide 2 important effects: improving your current lipid profile and preventing weight gain. Aerobic exercise (walking, running, swimming etc.) has been shown to have benefit in raising HDL levels but the effect depends on the amount and intensity of the exercise. For example, if you run at a speed that lets you achieve at least 70% of your maximum predicted heart rate (220-age = maximum predicted heart rate) for 30min 3-4 times per week, HDL may increase by ~10%. The frequency of exercise seems to be more important than the level of intensity. It’s recommended that we exercise no less than 30minutes/day for at least 5 times a week. With regards to LDL, most often no significant changes will be seen on your blood test. But don’t think that means exercise has no effect on LDL. In fact, exercise changes the type of LDL from small, dense particles to larger ones. Smaller, dense LDL is known to cause more heart disease than the larger LDL particles.

Lastly, diet and exercise are fundamental in weight management. Obesity has a completely negative effect on all lipid levels. This is in addition to its independent effect of increasing heart disease risk. If you are overweight, losing 10lbs may decrease your LDL level by 5-8%.

In summary, there’s a lot you can do to help improve your cholesterol without having to resort to prescription medication. If you are able to achieve all of these therapeutic lifestyle changes as mentioned above, the total net benefit may be a LDL reduction of 20-30% - that’s equivalent to taking 10mg of simvastatin, 20mg of lovastatin, or 40mg of fluvastatin. But even if you have to take prescription medication, these therapeutic lifestyle changes still have significant value and should be followed to the best of your motivational ability. Remember that a little TLC can go a long way.

Steven Kang, M.D., is a general cardiologist and cardiac electrophysiologist who believes that the best way to treat heart disease is to prevent it. He wrote for HealthCentral as a health professional for Heart Disease, High Blood Pressure, and High Cholesterol.